Zang Fu Patterns: LV Main Patterns Flashcards
What are the two primary functions of the Liver?
- Liver ensure smooth flow of Qi (throughout the body, in all directions)
- Liver stores Blood (Xue)
What is the importance of free flowing qi?
Any activity that depends on Qi depends on the Liver’s flowing and spreading function. Gan rules the evenness of Qi flow, smooth, unobstructed movement of Substances through the body and hence the harmony and regularity of body functions and behaviour.
Failure of this function forms the basis of Gan pathology. It results in obstruction, blockage and stagnation of not only the flow of Qi but other substances by connection to qi.
What are the four main facets of the free-flowing function of Gan?
- Harmony of Emotions
- Harmony of Digestion
- Secretion of Bile
- Harmony of Menstruation
How does obstruction of qi flow affect emotions?
When Qi flows normally, emotions are approximate and easy. When the spreading of Qi impaired or the circulation of Qi restrained, there is a disharmony between the individual and environment. This involves the intellectual faculties of planning and decisions making. There will be emotional depression, frustration, repressed anger, and physical symptoms.
What emotion is most connected to Liver disharmony?
Anger: “Anger makes Qi rise and Blood stagnate in the chest.”
What are the primary symptoms that result from Liver Qi stagnation?
Stagnation along channels related to Liver: hypochondriac and costal pain, “plum pit Qi”, chest oppression, swollen/tender breasts and genitals, lower abdominal pain.
How is the harmony of digestions affected by impairment of Qi flow?
Digestion and the Liver - Five element: Wood controls Earth.
The Gan function of free flowing of Qi is necessary for the activity of Pi and Wei (SP/ST) in digestion and is important to ensure harmonious Qi movement in the Middle Burner. Also if Gan is disharmonious, stagnant Gan Qi may overflow, “invade” or “attack” horizontally into Pi and Wei (Wood overacts on Earth)
How does the obstruction of Qi flow affect secretion of bile?
Smooth flowing of Liver Qi affects bile flow. Stagnant Liver Qi can obstruct bile flow (bitter taste, belching, or jaundice).
How does obstruction of qi flow affect harmony of menstruation?
The free flowing function of Gan is important for menstruation where there must be an even, unobstructed flow of Qi and Xue. This is related to the second function of the Liver, storage of Blood.
What is the Liver’s role in storing blood (TCM)?
Gan stores Xue, and regulates the quantity of Blood in circulation at any given time. When the body is active, Xue moves out of Gan into circulation and returns to the Liver at rest. Disharmony of this function may result in too little or too much Xue in circulation or in irregular fluctuations in the volume of circulating Xue.
How does the TCM liver function of storing blood correlate with true physiological function?
The liver produces albumin, the most abundant protein in blood serum. It is essential in the maintenance of oncotic pressure, and acts as a transport for fatty acids and steroid hormones. If there is not enough albumin, water leaves the blood vessels and causes swelling and low blood pressure.
The liver synthesizes angiotensinogen, a hormone that is responsible for raising the blood pressure when activated by renin, an enzyme that is released when the kidney senses low blood pressure.
How does the Liver storage of blood affect energy level and muscle function?
When at rest, Blood returns to Liver (Liver contributes to restoring energy). When body is active, Blood nourishes muscles to enable them to perform.
Blood regulation function influences energy level: if this function impaired, lack of Blood (= nourishment) where needed, hence easily tired.
If Liver Blood is deficient, there can be muscle cramps, tics and twitches or tremors/shaking in muscles. (Liver Wind from Blood Deficiency)
What is the liver’s role in gynecology?
Liver is very important in gynecology. If Blood storage function is abnormal, e.g. Liver Blood is deficient, menstrual problems e.g. amenorrhea, oligomenorrhea. If Liver is Hot or Excess, menorrhagia or metrorrhagia can occur.
If Liver Qi stagnant, Liver Blood can stagnate (dysmenorrhea, PMS, dark clots).
Liver malfunction influences energy of Ren Mai & Chong Mai which are closely related to uterus.
How do blood and liver function affect each other?
Blood & Liver function reciprocally affect each other. Where Blood is Deficient or Hot, Liver function can be affected. If Liver function abnormal, can affect quality of Blood. For example: If Liver is Hot, Blood can become Hot (causing skin eruptions, eczema, etc.: Blood becomes heated by being stored in a hot “container”).
What are all of the main functions of the Liver?
- Ensures smooth flow of Qi
- Stores blood
- Rules the Tendons (controls sinews)
- Opens into the eyes
- Manifests in the nails
- Houses the Hun (ethereal soul)
- Influences rising and growth
- Controls planning
How does the Liver rule the tendons (and affect muscles)?
The Liver controls the Sinews (tendons), or the contractile aspect of the muslces. The Spleen controls the muscles, or the mass or bulk. Liver imbalances are more likely to affect movement, and Spleen weakness more likely affects flaccidity, atrophy, etc.
How does liver blood affect tendons?
Sinews (tendons) depend on Liver Blood to moisten and nourish them so they can contract and relax as needed (smooth movement of joints and good muscle action). Deficient Liver Blood leads to lack of nourishment in the tendons, which leads to contractions, spasms, impaired extension/flexion, numbness of limbs, cramps, tremors, muscle weakness, etc.
All of the Zang Fu are involved in the proper function of the eyes and various Zang Fu disharmonies manifest in the eyes. Which functions/disharmonies are associated with the liver?
Gan Qi is associated with the ability to distinguish colours and with good vision.
- Deficient Gan Xue results in blurred vision, myopia, “floaters” color blindness, dry “sandy” eyes.
- Heat or Blazing Gan Fire results in red, sore and irritated eyes
- Stirring of Gan Wind results in tremor of the eyeball
Liver manifests in the nails, how do they look in health and disharmony?
If Gan stores and regulates Xue properly the nails are pink and well-formed. The finger and toe nails are the outgrowth of sinews and are influenced by Liver Blood. When Liver Blood is deficient, the nails will lack nourishment and become pale or dark, indented, dry, cracked, brittle, etc.
Liver houses the Hun, what does this mean?
The Hun is also called the ethereal Soul. Hun is related to ability to be resolute, to plan and have creative drive and assertiveness. When the Liver is out of balance in excess for instance, this becomes anger.
How does the liver influence rising and growth?
Energy moves up and out like tree (Wood element). The liver also relates to growth in the sense of personal growth, ability to change. People who feel stuck in life or a situation usually have Liver Qi Stagnation.
How is the liver connected to planning?
Liver gives capacity to plan. Said to be like General of an army (Gall Bladder gives ability to make decisions, hence very closely linked).
What are signs that are most common to all Gan Patterns of disharmony?
Digestive disorders, emotional disharmonies (irritability, anger), menstrual or testis problems (free flowing qi)
Afflictions of the tendons, eyes and head eg. numbness of limbs, trembling hands, convulsion (Tissues and Orifices ruled by Gan)
Distending, burning or dull pain in chest/hypochondrium, lower abdomen and head, dizziness and blurred vision (Gan Jing Luo passes through and connects with head, eyes, hypochondriac and genital regions)
What are the common Liver disharmony patterns?
- Liver Qi Stagnation
- Liver Blood Stagnation
- Liver Fire
- Liver Blood Deficiency
- Liver Yin Deficiency
- Liver Yang Rising
- Stirring of Liver Wind
- Cold Stagnation in the Liver Channel
- Damp-Heat in the Liver and Gallbladder
What are the most common etiologies of liver disorders?
- Emotional Disturbance According to Five Element theory, anger and other related emotions such as resentment, unfulfilled desires, frustration, etc. are attributed to the Liver. The relationship between an organ and its corresponding emotion is reciprocal. The Liver for instance, is responsible for the free and smooth flow of Qi, which has a deep relationship with a person’s emotional state. Conversely, anger, repressed emotions, etc. affect the Liver organ itself, and disrupt the smooth flow of Qi in the body.
Over a long period of time, stagnation of Liver Qi impairs circulation of Qi and can cause emotional states of constant low level anger, depression, and resentment. These may be transferred to and appear in the physical body, such as the chest, breasts in women, hypochondriac region, epigastric region, or throat. Stagnation of Liver Qi, therefore, produces feelings of tightness in the chest and hypochondriac region, often with frequent sighing, pain and swelling of the breasts, tension in the stomach, the sensation of a lump in the throat.
Liver Qi may “rebel” upward and cause Liver Yang to rise. Symptoms include irritability, headaches, and the propensity to lose one’s temper.
- Diet Excessive greasy and hot foods can cause Liver Fire. Examples of hot foods: Lamb, beef, curry, and other spices. Examples of damp or greasy foods: Deep fried food and alcohol.
Not enough warming foods, such as meat and grains, can contribute to inadequate Blood production and Blood Deficiency. Blood Deficiency, in turn, can lead to Liver Blood Deficiency. Women are particularly prone to Blood Deficiency especially at puberty, after childbirth, and somewhat after each period.
What is the etiology of Liver Qi Stagnation?
- Emotional disharmony, especially repressed anger, resentment, frustration, over a long time, which impairs the circulation of Liver Qi.
- Invasion of pathogenic factors
- 1 & 2 —> Stagnation of liver qi —> accumulation of phlegm, blood stasis
- May have preexisting LV BL Xu
- May have preexisting KI Xu
Why are women more prone to Liver Qi Stagnation during premenstrual time?
Women during the premenstrual time are naturally more prone to stagnation-related problems, since at this time Blood is collecting in the uterus and Qi levels are diminishing.
What are some Western diseases associate with Liver Qi Stagnation?
Chronic hepatitis
Chronic cholecystitis
Chronic gastritis
Gastric/duodenal ulcers
Menopausal syndrome
Mental Health problems
What key signs of Liver Qi stagnation arise from Jing Luo pathology?
Sensation of distention in hypochondrium and chest, sighing, sensation of Plum Pit Qi, lumps along Jing Luo
The pain is not severe, may move in location and come and go. Depression of Gan may invade the throat combining with Phlegm to cause the feeling of a lump in the throat. This also comes and goes with depression. Qi and blood may stagnate along the course of the channel forming lumps.
What key signs of Liver Qi Stagnation are connected to the emotions?
Depression, frustration, irritation, anger
Physical, emotional and mental vitality are stagnant and depressed, the individual has low spirits. Depression may be punctuated with outbursts of anger and irritability.
This pattern emphasizes the important of emotional disturbance in etiology. Depression may precipitate digestive and gynecological disharmonies as well as pain and discomfort along the course of Gan Jing Luo.
What are the key signs of Liver Qi Stagnation associated with digestion?
There is a very close relationship between Gan and Dan, Pi and Wei. If depression of Gan Qi invades Pi/Wei, there may be a mixture of these organ signs. If Gan invades Wei predominantly, Qi tends to ascend causing nausea, belching, sour regurgitation, vomiting and epigastric pain. If it invades Pi, Qi tends to descend causing borborygmus, loose stools and abdominal pain.
What are the key signs of Liver Qi Stagnation associated with bile?
If depression of Gan Qi impairs bile secretion, there may be jaundice, bitter taste and vomiting of yellow fluid (along with the general digestive disharmony like loss of appetite and nausea)
What is the pathology and key signs of Liver Qi stagnation associated with gynecology?
In menstruation Gan communicates with teh uterus via Ren Mai and Chong Mai. Gan, Ren Mai and Chong Mai are all concerned with the unobstructed movement of Qi and Blood during menstruation. Interrupted and uneven flow of Qi and blood may result in irregular and scanty menstruation. Sensation of depression and irritability, distention of abdomen and breasts may build up prior to menstruation and decline once it commences.
Liver Qi Stagnation Sn/Sx
Distention and pain in the chest and hypochondriac region
Areas coursed by the Liver channels
Frequent sighing
Releasing Stagnant Qi in the chest
Depression, moodiness, melancholy, unhappiness, and a general tense feeling
Flow of Liver Qi affecting the emotions or vice versa
Sensation of a lump in the throat with trouble swallowing
Internal branch of the Liver channel ascends along the neck and throat
nausea, vomiting, epigastric pain, reduced appetite, sour reflux, belching, awareness of pulsating (abdominal aorta) in the epigastric region, a sensation of the Stomach churning
Liver invading the Stomach
Abdominal distention, borborygmus, diarrhea
Liver invading the Spleen
Alternating Constipation and Diarrhea, irregular elimination
Liver Qi stagnating in the Intestines
Irregular menstruation, dysmenorrhea, premenstrual breast tenderness, PMS
Liver channel is closely associated with menstruation
Tongue: Normal tongue body (thin and white tongue coating)
Pulse: Wiry pulse
Liver Qi Stagnation POT and Herbs
POT: Disperse the liver and regulate qi
Herbs: Chai Hu Shu Gan San (Bupleurum Powder to Spread the Liver)
Liver Qi Stagnation Point Px
LIV-3 (Taichong - Great Surging) Shu Stream/Earth, Yuan Source, Heavenly Star; Regulates Liver Qi and especially effective when the throat is involved
GB-34 (Yanglingquan - Yang Mount Spring) He Sea/Earth, Meeting Point of Sinews, Heavenly Star; Regulates Liver Qi and especially useful when the hypochondriac region in involved
LIV-13 (Zhangmen - Completion Gate) Front Mu of SP, Meeting Pt of Zang, Origin of Dai Mai; Regulates Liver Qi in Middle Jiao, especially when it affects the Stomach
LIV-14 (Qimen - Cycle Gate or Gate of Hope) Front Mu of Liver, Exit Pt to Lung, Spirit Pt; Regulates Liver Qi in the Middle Jiao, especially when it invades the Spleen
SJ-6 (Zhigou - Branch Ditch) Jing River/Fire/Horary; Regulates Liver Qi and especially affects the sides
P-6 (Neiguan - Inner Pass) Luo Connecting, Confluent with Yin Wei paired with SP4 of Chong; Regulates Liver Qi and is especially good when emotional problems are major symptoms
SP4 (Gongsun Grandfather Grandson) Luo Connecting Pt; Confluent with Chong Mai; Regulates Pi and Wei, relieves indigestion and gastric pain.
ST18 (Rugen - Root of Breast) Great Luo of Stomach; Specific for breast problems
Flaring up of Liver Fire Etiology
- Emotion: Long-standing state of anger, repressed anger or frustration which causes Qi to stagnate and form Heat.
- Depression of Gan Qi, Stagnation gives rise to Heat that flares up as fire
- Diet: Excessive consumption of alcohol, fried foods, meat also tend to cause Liver Heat. Especially meats such as beef and lamb, which are attributed to hotter energy.
- Past history of Internal Heat or Deficient Gan Yin
- Pathogenic heat attacking liver channel
Blazing Gan Fire (Flaring up of Liver Fire) Pathology
General Excess Heat signs such as red tongue with yellow coat, full rapid pulse, thirst, bitter taste, constipation etc. These signs arise from the damage heat causes to Yin and Jin Ye and hence on Shen, Shen has no residence and insomnia results. Blazing Liver Fire can turn into Blazing Heart Fire and the two are closely related.
Blazing Gan Fire is distinguished by sudden severe signs of anger, headache, tinnitus and deafness. These result from sudden ascent of hot Qi and Xue to the head, ascending the Gan and Dan channels with their distributions in the vertex and temporal regions respectively.
This pattern is the extreme case of failure of the free flowing function of Gan Qi resulting in disharmony between the individual and the environment. The individual may be hypersensitive and liable to explode with rage. May have outbursts of extreme anger, perhaps involving physical violence.
Liver Fire Flaring Up Sn/Sx and Pathology
Red face and eyes, Irritability, angry outbursts, tinnitus, deafness, temporal headache, or migraine, dizziness
Liver Fire rising to the head
Thirst
heat damaging fluids
Bitter taste in the mouth
Liver Fire rising to the mouth
Constipation with dry stools
Heat damaging fluids
Insomnia with dream disturbed sleep
Liver Fire disturbing Shen
Dark yellow urine
Heat burning fluids
Possible epistaxis, hemoptysis, hematemesis
Liver Heat causes Blood to extravasate
Liver Fire Flaring Up POT and Herbs
POT: Sedate Liver, clear fire
Hersb: Long Dan Xie Gan Tang
Liver Fire Flaring Up Point Px
LIV-2 (Xingjian - Moving Between) Ying Spring/Fire; Clears Liver Fire
LIV-3 (Taichong Great Surge) Shu Stream/Earth, Heavenly Star, Yuan Source; Sedates the Liver
GB-20 (Fengchi - Wind Pool) Clear Liver Fire, pacify rising Liver Yang. Especially useful where eye problems or headache
M-HN-5 TaiYang (Extra Point) Clear Liver Fire and treats temporal headache (bleed with BL2)
BL2 (Zanzhu Gathered Bamboo) Bleed this along with TaiYang to disperse heat locally and pacify mind.
GB 13 (Benshen - Root of Spirit) Subdue ascending Liver Yang and calms the Mind
Method: Sedate all points
KD1 (Yongquan - Gushing Spring) Entry Pt, Jing Well/Wood/Child Pt; May be added to pacify fire, strengthen Yin and calm Shen. Indicated for headache at vertex, vertigo, blurred vison and mental health problems.
Liver Fire Flaring Up Western Diseases
- Hypertension
- Abnormal uterine bleeding
- Migraine
- Acute conjunctivitis
- Glaucoma
- Otitis
- Meniere’s disease
- Hemmorrhage of upper digestive tract
- Violent behaviour
How is the liver related to water metabolism?
If qi moves, blood moves. If qi is stuck, blood is stuck. Need free flow of qi to move water and blood. LU/SP/KI related to water metabolism but first we need free flow of qi.
If the Liver affects menstruation and ovulation for women what does it do in terms of reproduction for men?
Promotes ejaculation for men.
What vital substances does the Liver have?
Qi, Yang, Yin, Blood
What is the … for the Liver?
… Liquid
… Pulse
….Season
….EPI
Liquid is tears
Pulse is wiry
Season is spring
EPI is wind
What are the causes of tremors/contractions or convulsions?
- Liver fails to nourish tendons, tendons contract creating abnormal movement —> sign of wind
- Exterior heat burns the tendons causing convulsions (wind). This is purely an excess condition (example: kids with a fever can easily turn into wind convulsions)
What are the primary symptoms of a liver disorder?
Hypochondriac pain (often distending), temple headache, lower abdominal (side) and groin area pain (eg. abdominal hernia, testicle/scrotum pain)
What are the secondary symptoms of a liver disorder?
Irritability, dizziness, trembling, convulsion, blurred vision
Liver Blood Deficiency Etiology
- Xu of SP/ST (not enough protein in the diet or an irregular/poor diet can weaken Spleen) —> Insufficient production of Blood —> Liver does not have enough Blood to store —> LV Blood Xu
- Prolonged illness or blood loss from serious hemorrhage will injure liver blood
- Injury of Gan, Yin or Jin Ye by heat (fever or Blazing Gan Fire)
- Kidney Qi or Kidney Jing Deficiency can cause Deficient Blood as Kidneys play an important role in production of Blood and Qi (less common)
Liver Blood Xu Western Diseases
Anemia
Stress (nervouse exhaustion)
Hypertension
Chronic Hepatitis
Amenorhea (menstrual disorder)
Night blindness
Chronic eye problems
Liver Blood Deficiency Pathology
The concept of Liver Xue relates to the storage of Xue (blood) and regulation of volume. Deficient Xue means Deficient Gan Xue and the two patterns share blood xu signs and greatly overlap such that in clinical practice they are often used synonymously.
What signs to Liver Blood Xu and Blood Xu share?
Dull, pale complexion
Listlessness, emaciation and dizziness
Numbness or weak tremors in limbs
Thin, choppy pulse
Pale, dry, thin tongue
What signs do Liver Blood Deficiency have that general Blood Deficiency does not?
Dry eyes, spots in the visual field - Liver opens to eyes, when Liver Blood is deficient, eyes may lack nourishment
Pale, brittle nails - Liver manifests in nails
Muscle spasms - Liver Blood fails to nourish tendons, causing weakness, cramping and hypertonicity
Scanty menses - The Ren Mai and Chong Mai also depend on the Liver for their Blood supply. When Deficient Liver Blood does not provide Blood to these channels, it leads to scanty menstruation or amenorrhea
Wiry pulse
What are the primary signs of Liver Blood Xu?
Blurred vision and floaters in the eyes
Liver Blood not nourishing the eyes
Scanty menstruation and amenorrhea
Deficient Liver Blood not nourishing the Ren Mai and Chong Mai
Dull pale face, dizziness, orthostatic hypertension, pale lips
General Blood Deficiency
Numbness of the Limbs, muscular weakness, muscle spasms, cramps
Liver Blood not nourishing the muscles and tendons
Pale, withered, and brittle nails
Liver Blood not nourishing the nails
Tongue: Pale, especially on the sides, little or not coat. In severe cases, the sides may be orange
Pulse: Choppy and/or fine pulse
Liver Blood Xu POT and Herbs
POT: Tonify the Liver; Nourish blood
Main POT is to strengthen blood and function of Gan to store blood. Reinforcing method is used. It is unlikely to be seen in isolation in clinic, will often be seen with Gan Yin Xu or general Blood Xu.
Herbs:
Bu Gan Tang (Tonify the Liver Decoction)
Liver Blood Xu Point Px
BL-18 (Ganshu Liver Shu) Tonifies Liver and Liver Blood, brightens the eyes
BL-20 (Pishu Spleen Shu) Tonifies Spleen to produce Blood, strengthen transformation function if Pi and Wei.
BL-23 (Shenshu)
Tonifies Kidneys to produce Blood
BL-17 (Geshu)
Direct moxa to tonify Blood
LIV-8 (Ququan)
Tonifies Liver Yin and Blood
ST-36 (Zusanli)
Tonify Qi of Middle Burner to produce Blood
SP-6 (SanYinjiao)
Tonify Qi of Middle Burner to produce Blood
REN-4 (Guanyuan)
Direct moxa to tonify Blood
Method
Tonify. Moxa is applicable
Disharmonies related to Gan Xue Deficiency
As discussed before, it is often related to general Xue Deficiency.
It may also be associated with Liver Qi Stagnation (Depression of Gan Qi) causing irregular storage and release of Xue, resulting in irregular menstruation.
May also combine with Xue Heat, resulting in excess Xue in circulation and a tendency of Xue to leave the vessels (menorrhagia, metrorrhagia)
May also result in Stirring of Gan Wind
Liver Yin Deficiency Etiology
- Emotional frustration —> depression of qi –> fire
- Liver diseases —> injure liver yin
- Febrile diseases —> injure liver yin
- Excessive activity, overwork
- Excessive sexual activity
- Improper diet eg. excessive intake of extremely warming foods
- Sleep deprivation
- Excessive drug and medication use
- Depletion of blood/body fluids
Liver Yin Deficiency Western Diseases
- Hypertension
- Eye disease
- Chronic hepatitis
- Mental health problems
- Menopausal symptoms
Liver Yin Xu Sn/Sx
Dizziness, blurred vision, dryness of eyes, burning pain in costal and hypochondriac regions, depression, aimlessness Liver qi stagnation plus heat signs
5-centre heat, afternoon fever, night sweats, dryness of mouth and throat, flushed face but only cheekbones Yin Xu signs
Withered, brittle nails, dry hair and skin, muscular weakness, dull, pale complexion, amenorrhea - blood deficiency, Liver controls storage of blood
Involuntary movement of limbs, numbness and tingling of limbs - liver controls tendons
Tongue: Red body without coating or with rootless coating
Pulse: Floating, empty, wiry, rapid
Liver Yin Xu POT and Herbs
POT: Nourish Liver Yin, Clear Deficient Heat
Herbs: Yi Guan Jian (Linking Decoction)
Liver Yin Deficiency Point Px
KI10 (Yingu Yin Valley) He Sea/Water Pt/Horary; Benefits KI, Clears damp-heat, indicated in Five Phase treatment with LV8
LV8 (Ququan Sprint at the Crook) He Sea/Water/Mother; Nourishes blood and yin, invigorates blood and benefits uterus, clears damp heat
RN4 (Guanyuan Gate of Origin) Front Mu of SI; Nourishes Original Qi and essence, tonify and nourish KI
KI3 (Taixi Supreme Stream) Shu Stream/Earth, Yuan Source; Nourish KI yin and clear deficiency heat
KI6 (Zhaohai Shining Sea) Confluent of Yin Qiao coupled with LU7 of Ren; Nourish KI and clear deficiency heat,
SP6 (Sanyinjaio) Meeting of SP with LV and KI, C/I in pregnancy; Harmonizes LV and tonifies KI, invigorates blood
ST36 (Zusanli Leg Three Mile) He Sea/Earth/Horary, Heavenly Star, Sea of Water/Grain, Command Pt of Abdomen; Tonifies qi and nourishes blood and yin, clears fire and calms spirit,
Yu Yao EX-HN-4 (Fish Waist) Benefits eyes, relaxes sinews and relieves pain
Liver Yin Xu (Gan Yin Deficiency) is a central pattern or precursor to what other three patterns?
Deficient Gan Xue
Hyperactive Gan Yang
Blazing Gan Fire
What patterns may lead into Deficient Gan Yin?
Prolonged Internal Heat
Deficient Shen Yin
Deficient Xue
Deficient Gan Xue and Deficient Gan Yin form a _________ in which one pattern may _________
at any given time.
continuum; predominate
What is the order of patterns based on precursor/severity for Hyperactive Gan Yang, Deficient Gan Yin and Blazing Gan Fire?
eg. of a symptom increasing in severity
Deficient Gan Yin —> Hyperactive Gan Yang —> Blazing Gan Fire
Headache may be mild, moderate or severe
How can you differentiate Hyperactive Gan Yang from Blazing Gan Fire?
Although Hyperactive Gan Yang has some signs of Excess it is based on xu and weakness and can be differentiated by Blazing Gan Fire by the greater strength of signs in case of the latter.
What would be examples of headache for Hyperactive Gan Yang and for Blazing Gan Fire?
Hyperactive Gan Yang - distending and throbbing
Blazing Gan Fire - severe and splitting
Differentiate emotional problems for Hyperactive Gan Yang vs Blazing Gan Fire.
Hyperactive Gan Yang - small outbursts of moderate anger
Blazing Gan Fire - may be violent fits of rage
Differentiate heat signs between Deficient Gan Yin and Blazing Gan Fire.
Deficient Gan Yin - Palms and soles hot, malar flush, thin and rapid pulse
Blazing Gan Fire - whole body hot, whole face red, pulse full and rapid
Deficient Gan Xue, Hyperactive Gan Yang and Blazing Gan Fire may all give rise to what pattern?
Stirring of Gan Wind
What patterns of damp may develop from Depression of Gan Qi, Deficient Gan Xue, Hyperactive Gan Yang, Blazing Gan Fire or Stirring of Wind?
Damp Heat in Gan and Dan
SP disharmony: Turbid Phlegm Disturbing the Head (in some patterns of Wind corresponding to CVA)
Hyperactive Gan Yang Etiology
This both an excess and deficient pattern. The excess being the Rising Liver Yang and heat, the deficiency usually being that of Liver Yin and/or Kidney Yin. In Five Element theory, Water fails to nourish wood.
Hyperactive Gan Yang Pathology
Gan Yin insufficient to control Gan Yang which rises to the upper part of the body and head. Yang rises carrying Excess Qi and Xue to the head with feelings of fullness and distention especially in Liver channel area of vertex and temporal area (GB)
What is the difference between Liver Fire Blazing and Liver Yang Rising?
Liver Fire Blazing is a true Excess pattern where it produces Excess Fire that dries up Body Fluids and causes signs of Dryness, such as constipation, red eyes, scanty and dark urine, bitter taste, etc. Liver Yang Ascending does not have full Heat signs because the excess is due to deficiency
Hyperactive Gan Yang Western Diseases
- Hypertension
- Headaches
- Emotional disturbance
- Hyperthyroidism
- CVA sequellae
- Vertigo
- Tinnitus
- PMS
- Anemia
Hyperactive Gan Yang Sn/Sx and Pathology
Headaches (temporal/parietal, unilateral (Gall Bladder) Liver Yang rising to the head
Dizziness, tinnitus, sudden deafness
Liver Yang rising to the head
Dry mouth and throat - Heat
Insomnia - Liver Fire disturbing the Shen
Irritability, shouting in anger, stress - Liver Yang Rising
Palm and soles hot, dry eyes, spots in visual field, dizziness, dry mouth, insomnia - Deficient Gan Yin
Numbness, spasm and tremor - Liver controls tendons
Tongue: Red with redder sides
If due to Liver Blood Deficiency, the tongue is pale
If due to severe Liver and Kidney Yin Deficiency, the tongue is red and peeled
Pulse: Wiry Pulse
If due to Liver Blood Deficiency, the pulse is choppy and more deficient.
If due to severe Liver and Kidney Yin Deficiency, the pulse is floating and empty
Hyperactive Gan Yang POT and Herbs
POT:
Subdue Liver Yang
Tonify Liver Yin
Herbs:
Tian Ma Gou Teng Ying (Liver Windclear)
Hyperactive Gan Yang Point Px
LIV-3 (Taichong Great Rushing) Shu Stream/Earth, Yuan source, Heavenly Star; Subdues Liver Yang. Used more in chronic cases, separate from LV2.
LV2 (Xingjian Moving Between) Ying Spring/Fire Pt; Clear Liver Fire. Both LV2 and LV3 pacify Hyperactive Gan Yang. LV2 more in acute cases. Used separate from LV3.
SJ-5 (Waiguan - Outer Pass) Luo Connecting Pt, Confluent of Yang Wei Mai coupled with GB41 for Dai Mai; Subdues Liver Yang
SP-6 (SanYinjiao Three Yin Meeting) Harmonizes LV and tonifies KI.
KID-3 (Taixi Supreme Stream) Shu Stream/Earth, Yuan source; Tonify Kidney Yin - if strong underlying deficient yin pattern. Can also add BL23.
LIV-8 (Ququan Spring at the Crook) He Sea/Water/Mother; Tonify Liver Yin
GB 43 (Xiaxi Clamped Stream) Ying Spring/Water/Mother; Subdue Liver Yang. Especially good for headache on Gall Bladder channel
GB 38 (Yangfu Yang Assistance) Jing River/Fire/Child Pt; Subdue Liver Yang and Liver Fire, good for chronic and stubborn migraine headache (sedation point)
BL-2 (Zanzhu Gathered Bamboo) Subdues Liver Yang, local point for headache around eye
TaiYang EX-HN-5 (Extra Point)
Subdues Liver Yang, local point for headache on temple
GB-20 (Fengchi Wind Pool) Subdues Liver Yang, use as local pt for headache in occiput or headache around eye
GB-9 (Tianchong Heavenly Rushing)
GB-8 (Shuaigu Leading Valley)
GB-6 (Xuanli Suspended Hair)
GB 6,8,9 all subdue Liver Yang, important local points for headaches on the lateral aspect of head
DU20 (Baihui Hundred Meetings) Pt of Sea of Marrow; Pacifies wind and subdues Yang, calms Shen.
Method:
Sedate points that subdue Liver Yang
Tonify points that nourish Yin
What are the different types of Stirring Up of Liver Wind?
- Liver Yang turning into wind
- Extreme heat producing wind
- Deficiency of Yin Stirring Wind
- Deficiency of Blood Stirring Wind
Liver Yang Turning Into Wind Etiology
- Long standing yin deficiency of the LV/KI —> abnormal rising of LV yang —> stirring wind in the interior
- This pattern is a combination of deficiency and excess, usually caused by emotional factors, especially due to a continuous state of anger, resentment, frustration, etc
The Yin and Blood of the Liver depend on the nourishment of Kidney-Yin and Essence because the Kidneys correspond to the water element, which should nourish wood, the Liver element. Thus, if Kidney fails to nourish, Liver-Yang upbears and stirs unchecked.
Liver Yang Turning into Wind Pathology (Hyperactive Yang producing Wind)
There may be signs due to Deficient Gan Yin, Hyperactive Yang and Blazing Gan Fire, but the most important are signs due to the turbulence caused by the uprush of Yang, resulting in disturbance of Heart and Brain, Shen and senses and thus in loss of consciousness or mental disorientation, with possible impairment of speech. If turbulent Yang and Fire invade Jing Luo of the upper Body, they may disrupt the flow of Qi and Xue with hemiplegia or facial paralysis.
Liver Yang turning into Wind Western Diseases
- Hypertension
- Cerebrovascular accident
- Epilepsy
Hyperactive Gan Yang Producing Wind Sn/Sx
Dizziness, vertigo that upsets balance, unsteady gait - Liver gan xu or stagnation signs
Headache with shaking of the head, stiff neck, numbness and trembling of limbs, convulsions (epilepsy), hemiplegia (stroke) - liver controls tendons
Sudden loss of consciousness, deviation of mouth and eyes, mental disorders, aphasia, dysphasia - turbulence of Yang affecting Shen and Senses
Pulse: floating-empty, or wiry-fine, and rapid (or forceful says Jiu Lin)
Tongue: red body, white or sticky coating or red peeled (yin xu) and/or deviated
Note: relatively mild heat signs if they are present compared to Extreme Heat pattern
May have Liver and Kidney Yin deficiency signs
Hyperactive Yang turning into Wind General POT and Herbs
POT: Combined method
- Nourish yin to subdue Liver Yang
- Extinguish Liver Wind
- Regulate Liver
Herbs:
Tian Ma (Gastrodia), Gou Teng (Uncaria).
The formulas: Tian Ma Gou Teng Yin (Gastrodia and Uncaria Decoction) or Zheng Gan Xie Geng Gang (Sedate the Liver and Extinguish Wind)
What are the subtypes of Liver Yang Turning into Wind as it relates to Windstroke?
- Acute pattern associated with Zang Fu involvement, subdivided into “closed” and “abandoned” types
- Pattern of sequella of windstroke associated with Jing Luo involvement
Acute windstroke caused by Hyperactive Yang
“closed type” POT and method
- Clear the Orifices
- Drain Heat
- Pacify Rebellious Qi
Method: Reducing
Acute windstroke caused by Hyperactive Yang Stirring Wind “abandoned type” POT and method
Stabilize Yang
Method: Reinforcing
Pattern of Sequellae of Windstroke caused by Hyperactive Yang Stirring Up Wind POT and Method
- Clear Jing Luo
- Invigorate circulation of Qi and Xue
- Eliminate Wind
Method: Even method and moxa
points chosen according to area or function affected such as arm, leg, speech
Epilepsy or seizures caused by Hyperactive Yang turning into Wind
POT and method
- Clear Orifices of the Head (i.e. of the Senses)
- Transform Phlegm
- Pacify Gan Wind
Method: Reducing method during seizure (!not)
Even method between
Hyperactve Liver Yang Stirring Up Wind in the Interior
or
Liver Yang Turning into Wind
Point Px
KD1 (Yongquang - Gushing Spring) Jing Well/Wood/Child Pt, Entry Pt from BL67; Calms Shen, opens the orifices of the senses, specific point for epileptic seizures
Yaoqi (EX-B-9 or M-BW-29) Specific point for epileptic seizures
GB20 (Fengchi Wind Pool) Pacify wind, calm Shen
DU16 (Fengfu Palace of Wind) Point of Sea of Marrow, Window of Heaven, Ghost Point; Pacify wind, calm Shen
DU14 (Dazhui - Sea of Qi) Pacify Wind, calm Shen
DU26 (Renzhong Man’s Middle) Regulate Yin/Yang, open orifices of the head to restore consciousness
Extreme Heat Producing Wind Etiology
Excessive pathogenic heat burning the liver channel –> producing wind
Extreme Heat Producing Wind Pathology
The extreme turbulence and Heat caused by the violent upward movement of Fire and Yang is so disruptive to the flow of Qi and Blood that it results in extreme and uncontrolled movement and contraction of Muscles and Tendons; with convulsions, neck spasms and opisthotonos. The extreme Heat may injure Shen resulting in coma and delirium.
Extreme Heat Producing Wind Western Diseases
Hyperpyretic convulsion (from fever, usually infants)
Encephalitis
Epidemic encephalomyelitis fever
Epilepsy
Extreme Heat Producing Wind Sn/Sx
- Heat signs:* Severe, high fever
- Tendon involvement:* Convulsions (will often include upward staring eyes, locked jaw, clonic spasm), rigidity, opisthotonos
- Senses*: coma, delirium
- Pulse:* wiry, rapid, full
- Tongue*: scarlet, dry yellow coat
Extreme Heat Producing Wind POT and Herbs
POT: Remove heat from liver
Pacify liver wind
Herbs: Lin jiao gou teng tang
Extreme Heat Producing Wind Point Px and Method
GB20 (Fengchi Wind Pool) Pacify Yang, Fire and wind of Gan, calm the mind
LV3 (Taichong - Supreme Rushing) Yuan Source, Shu Stream/Earth, Heavenly Star; Pacify Yang, Fire and Wind of Gan, calm the mind
DU16 (Fengfu Palace of Wind) Point of Sea of Marrow, Window of Heaven Point, Ghost Point; Pacify wind, clear Brain, calm Shen, relieve muscle spasm
DU14 (Dazhui - Great Vertebra) Point of Sea of Qi; Clear heat, calm Shen, relieve muscle spasm
LI4 (Hegu - Joining Valley) Command Point of Face, Yuan Source pt, Heavenly Star, Entry Pt from LU7; Clears heat (esp in combo with DU14), relieves muscle spasm
Shixuan (M-UE-1) Bleed to clear heat and restore consciousness
Method: Reducing, moxa is contraindicated
Why is it important to use the DU channel when treating internal wind?
Du Mai controls all of the Yang channels (Governing Channel). The head and Du channel are especially prone to excess or turbulence of Yang (eg. Blazing Fire, Hyperactive Yang, extreme Heat or Internal Wind) because yang rises and because the yang channels all meet here.
Du Mai also has links with the brain and the Orifices of the senses. Excess or turbulence of Yang may result in loss of consciousness, extreme Heat may cause severe spasm of Muscles and Tendons. This is why Du points are important to regulate Yang to disperse Excess from Du Mai
Deficiency of Blood Stirring Wind Etiology
- Excessive chronic hemorrhage
- Prolonged illness
- 1 & 2 damage blood
- Deficiency of SP/ST –> Insufficient production of blood
1-4 –> Blood Xu –> Wind
Deficiency of Blood Stirring Wind Western Diseases
- Anemia
- Chronic Hepatitis
- Mental health - anxiety
- Tics and tremors esp of eyes and head
Deficiency of Blood Stirring Wind Sn/Sx
- Tendon involvement:* Numbness, spasm of head and extremities, trembling of hands and feet,
- Senses:* blurring of vision, dizziness
- Blood deficiency*: sallow complexion, pale lips and nails, dizziness, blurry vision
- Pulse:* Wiry, choppy, thin or thready
- Tongue:* Pale, dry, no coat or thin white coat
*Note: usually no heat signs
Deficiency of Blood Stirring Wind POT and Herbs
POT:
Nourish Liver blood to calm wind
Herbs:
Si Wu Tang
Deficiency of Blood Stirring Wind Point Px and Method
LV3 (Taichong - Great Rushing) Heavenly Star, Yuan Source, Shu Stream/Earth; Pacify Liver and disperse Wind
GB20 (Fengchi - Wind Pool) Pacify Liver and disperse Wind, esp. in the head
DU20 (Baihui - Hundred Convergences) Sea of Marrow Point along with DU16; Pacify Liver and disperse wind, esp. in the head
Above three all work together
LI4 (Hegu - Joining Valley) Yuan Source, Command Point of Head, entry point from LU7, Heavenly Star; Disperses Wind and clears channels
ST36 (Zusanli - Leg Three Miles) Command Pt of Abdomen, Heavenly Star Pt, Pt of Sea of Water and Grain, He Sea/Earth Pt; Strengthen function of ST/SP to form Blood (work with BL20)
BL20 (Pi Shu - Spleen Shu) Strengthen function of ST/SP to form Blood (works with ST36)
BL18 (Gan Shu - Liver Shu) Strengthens Liver Blood
BL17 (Ge Shu - Diaphragm Shu) Strengthens Blood
Method: Reinforcing
Stagnation of Cold in Liver Channel Etiology
- Invasion of pathogenic cold
- Internal cold (not expelled or from yang deficiency)
- Depression (stagnation) of Gan Qi
1-3–> accumulation of cold in liver channel –> impedes circulation of qi and blood –> may cause muscular spasm
Stagnation of Cold in Gan Jing Luo (Retention of Cold in Liver Channel) Pathology
Since Cold concentrates in the lower part of the body and since the Gan Jing Luo surrounds the genitals, pain and swelling may be especially prominent in these areas. Cold is characterized by contraction and by obstruction of Qi, accompanied by pain.
Retention of Cold in Liver Channel Western Diseases
- Inguinal hernia
- Intestinal adhesion
- Orchitis - inflammation of testicles
Retention of Cold in Liver Channel Sn/Sx
- Cold in the Liver Channel:* Fullness/distention of hypogastric region (lower abdomen); Men: pain in the scrotum/testes, contraction of scrotum; Women: it can cause severe dysmenorrhea which is relieved by heat
- Tongue* Pale and wet with a white coat
- Pulse* Wiry, deep, and slow pulse
*wiry or tight pulse may result from the combination of pain and cold
Stagnation of Cold in Gan Jing Luo POT and Herbs (Food bonus)
POT:
Warm the Liver to dispel Cold
(Invigorate circulation of qi to disperse Cold and clear the Gan Jing Luo)
Herbs:
Nuan gan jian
Food: fennel
Retention of Cold in Liver Channel Point Px and Method
Method: Use Even method of manipulation or could sedate LV1 and LV5 as this is an excess pattern. Moxa is applicable.
RN3 (Zhongji Central Pole) Front Mu Pt of UB; Moxa to disperse Cold from Lower Burner
RN4 (Guanyuan Origin Pass) Front Mu of SI
RN6 (Qihai - Sea of Qi) with RN4: Moxa to invigorate Qi and Yang, disperse Cold from Lower BurnerRN6
LV5 (Ligou - Woodworm Canal) Luo Connecting point; opens Luo channel which flows around genitals: can disperse Cold from the channel
LV3 (Taichong - Great Rushing) Yuan Source, Shu Stream/Earth Pt, Heavenly Star; Combine with LV5 to clear Gan Jing Luo and reduce pain in testes
LV1 (Dadun - Large Pile) Jing Well/Wood; Clears Liver channel and removes obstruction of Cold from Lower Burner; moves Qi in genital area
Liver Blood Stagnation Etiology
- Stagnation of LV qi leads to stagnation and blockage of blood causing abdominal masses
- Emotional frustration, depression or repressed anger over a long time
- Exposure to excess cold, heat or damp
- Inappropriate diet
- Blood deficiency causing qi to stagnate
Always derives from Stagnation of Liver Qi, therefore the etiology is the same, especially emotional problems.
Liver Blood Stagnation Western Conditions
- Cirrhosis of Liver
- Hepatomegally
- Splenomegaly
Liver Blood Stagnation Sn/Sx
- Abdominal masses, fixed, not moveable, fixed and stabbing abdominal pain
- Distention of epigastrum, hypochondrium, abdomen or hypogastrum
- Dysmenorrhea, irregular periods, dark and clotted menstrual blood
- Emaciation
- Enlargement of Liver and/or Spleen
- Epistaxis or vomiting of Blood
- Facial colour dark and dull (purplish appearance of complexion)
- Headaches (fixed or stabbing)
- Tongue: Dark red or purple (may be purple spots on sides of tongue)
- Pulse: Wiry, tight, choppy
Note: Emaciation and Enlargement of LV/SP are in more extreme cases and not usually present
Liver Blood Stagnation Treatment Principle
- Dispel blood stagnation
- Move liver Qi
- Soften masses
- Regulate blood
What are the distinctive signs of blood blockage?
- Sharp, fixed pain esp. abdomen or ribs
- Facial colour dark or dull
- Tongue: Dark purple, red or purple spots on sides
Liver Blood Stagnation Herbal Formulas
- Xue Fu Zhu Yu Tang (Drive Out Stasis in the Mansion of Blood Decoction)
- Ge Xia Zhu Yu Tang (Drive out Blood Stasis Below the Diaphragm Decoction)
- Yu Yu Wan (Gardenia Ligusticum Pill)
Liver Blood Stagnation Points and Uses
Method?
LV3 (Taichong - Great Rushing) Shu Stream, Earth Pt, Yuan Source Pt, Heavenly Star Pt; Spreads LV Qi and regulates blood
GB34 (Yanglingquan Yang Mound Spring) He Sea, Earth Pt, Meeting Pt of Sinews, Heavenly Star; Regulates Liver Qi to regulate blood.
RN6 (Qihai Sea of Qi) Regulates qi and harmonizes blood. Moves blood in abdomen, esp with abd pain.
LV13 (Zhangmen Completion Gate) Front mu of SP, Meeting Pt of Zang; Harmonize LV/SP. Regulate middle and lower jiao. Abdominal masses esp.
LV14 (Qimen Cycle Gate) Front Mu of LV; Transfroms and removes stagnant blood
SP6 (Sanyinjiao Three Yin Intersection) Meeting Pt of SP, LV and KI; Spreads LV Qi. Activates circulation of qi and blood.
UB17 (Geshu Diaphragm Shu) Meeting Pt of Blood; Transforms stagnant blood.
UB18 (Ganshu Liver Shu) Back Shu of LV; Spreads LV qi. Regulates and nourishes LV blood
SP10 (Xuehai Sea of Blood) Invigorates blood and dispels stasis. Cools blood.
Reducing method or even method on weak patients. No moxa.
